ANNAPOLIS – The Maryland Health Care Commission released its 2001 HMO report card Friday, a document that included new and very specific information tailored to consumers with chronic diseases and mental health needs.
Delmarva Health Plan and MD-Individual Practice Association were consumer favorites; Kaiser Permanente got the most above-average ratings in nationally-set health service standards.
Delmarva and Kaiser both received the highest number of “star performer” designations from MHCC. This title, conferred on HMOs for the first time last year, means a health plan has performed at above-average rates in a specific category three years in a row. Kaiser was a “star performer” last year.
Kaiser is one of the largest plans in the state, with about 477,000 Marylanders enrolled. Delmarva is one of the smallest, with about 22,500 Maryland enrollees, but it operates under CareFirst BlueCross BlueShield, which owns three other HMOs evaluated in the report.
One of the 12 HMOs reviewed in the report, George Washington University Health Plan, will stop services in 2002.
This year’s report included fewer consumer-response data and more data representing actual patient care than in previous years, state officials say.
“It’s more objective,” said MHCC spokeswoman Pamela Cheetham. “It has to do with our perception of how sophisticated people are becoming and the kind of information people want to know.”
For example, the consumer report last year provided percentages of diabetic adults who were tested for blood sugar and high cholesterol under each health plan. This year, the report also includes percentages of diabetic adults whose cholesterol and blood sugar were controlled.
“The emphasis is moving towards people who have more chronic disease care,” Cheetham said.
Delmarva, Free State and Capital Care, all three CareFirst BlueCross BlueShield companies, beat the HMO average of patients with controlled blood sugar by at least 10 percentage points. Preferred Health Network, also a CareFirst company, was more than 20 percentage points below average.
Free State had the highest percentage of diabetic patients with demonstrably controlled cholesterol, 51 percent. Delmarva and United Health Care had the lowest at 30 and 32 percent, respectively.
Mental health care is another area scrutinized in more depth this year. The 2001 report includes new information on the managed behavioral health care organizations with which Maryland HMOs contract out to provide mental health services.
All HMOs contracted with fully accredited behavioral health plans.
Of HMO-covered patients hospitalized for a mental disorder, fewer than half received a follow-up within a week of leaving the hospital; 70 percent had a follow-up within a month of leaving the hospital.
Kaiser patients had a better chance of getting a quick follow-up appointment than patients in other health plans: 60 percent of hospitalized patients saw a mental health practitioner the week after being discharged. Kaiser, CIGNA and MD-IPA had similar rates.
Almost 80 percent of Capital Care patients could get an appointment within a month after discharge, but only 20 percent were seen within a week.
Other health plans evaluated include Aetna U.S. Healthcare, Coventry Health Care, Optimum Choice and United Healthcare.
The comprehensive HMO quality report is available online at http://www.mhcc.state.md.us/hmo/_hmo.htm. A shorter consumer guide is also provided online. Hard copies of these reports are available at public libraries statewide, or by calling MHCC at (877) 245-1762.